A patient came in for evaluation of head congestion. As the nurse was getting his vital signs in the room, he asked her who the emergency physician was.
“Dr. WhiteCoat,” she replied.
He turned his head to the side and asked his wife over his shoulder “Is that the one?”
His wife answered “Yup.”
The nurse asked him if he had a problem with me in the past.
“Not unless you call some guy shoving his fist up your ass a problem.”
The nurse looked shocked.
“I came in here with abdominal pain and I threw up blood. This guy tells me he needs to ‘check my rectum for blood.’ Then he buries his arm in my ass up to the elbow. I could have told him there wasn’t any blood up there. He ain’t coming nowhere near me with a pair of gloves from now on.”
When the nurse relayed this story to me, I looked his old records up on the computer before going into the room. Four years ago he came in with abdominal pain and complained of pus in his stool. He ended up having a GI bleed, but no pus was ever found. So the rectal examination has scarred him for the past 4 years.
The nurse and I laughed for a minute about whether I should walk into the room with a gown, mask, gloves and a tube of KY Jelly.
Then I started thinking.
Not too long ago, another patient whom I evaluated for abdominal pain complained to our hospital administration that he was having “post traumatic stress” from the rectal examination I performed. He was afraid of interacting with men bigger than he was and could no longer stand in lines because he was afraid of what the people standing in line behind him might do.
It’s not like I have gorilla fingers. My finger is about 3 inches long and about 1.5 inches in circumference at its widest. Most formed stool is much longer and much wider than my finger, but I don’t know any adults who have developed post traumatic stress disorder from taking a dump. Reactions like this are why I routinely bring a chaperone with me when I do these exams – just to make sure that I don’t lose my wristwatch doing the exam, you know.
It’s not like doctors enjoy doing rectal exams. I can’t go home and say “Hey kids! I didn’t save anyone’s life, but guess what I did at work today!”
Oh, and clenching your butt cheeks together then arching your back in a seizure position doesn’t make things any easier. If you don’t want the exam, refuse it.
If you go to the emergency department to be evaluated for abdominal pain, vomiting blood, constipation, diarrhea, or abnormal stools, it’s nothing personal, but you’re going to need a rectal examination. It’s part of the job I do.
If you don’t complain about it, neither will I … well … at least not that much.